Abstract
Objectives: The goals of treating recurrent platinum-resistant ovarian cancer are palliative, aimed at reducing symptoms and improving progression free survival. A prospective trial was conducted to determine the prevalence and severity of symptoms, and associated care needs. Methods: Eligible women included those with persistent or recurrent platinum-resistant ovarian cancer with an estimated life expectancy of at least 6 months. The Needs at the End-of-Life Screening Tool (NEST), FACIT-Fatigue (FACIT-F), NCCN-FACT Ovarian Symptom Index [NFOSI-18]; Disease Related Symptoms (DRS), Treatment Side Effects (TSE), and Function/Well Being (F/WB) were collected at study entry, 3 and 6 months. Results: We enrolled 102 evaluable patients. Initiation of Do Not Resuscitate (DNR) discussions increased over time from 28% at study entry to 37% at 6 months. At study entry, the most common disease-related symptoms were fatigue (92%), worry (89%), and trouble sleeping (76%); 73% reported being “bothered by treatment side effects”, which included nausea (41%) and hair loss (51%) neither of which changed over time. The most common NEST unmet needs were in the symptom dimension. The social dimension was associated with F/WB (p = 0.002) and FACIT-F (p = 0.006); symptoms were associated with DRS (p = 0.04), TSE (p = 0.03), and FACIT-F (p = 0.04); existential was not associated with any of the patient-reported symptoms; therapeutic was associated with F/WB (p = 0.02). Conclusions: In patients nearing the end of life, there are significant associations between disease and treatment related symptoms and unmet patient needs, which do not change substantially over time. Careful exploration of specific end-of-life care needs can improve patient-centered care and QOL.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 119-126 |
| Number of pages | 8 |
| Journal | Gynecologic oncology |
| Volume | 150 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2018 |
Funding
This study was supported by National Cancer Institute grants to the Gynecologic Oncology Group (GOG) Administrative Office (CA 27469), the Gynecologic Oncology Group Statistical Office (CA 37517), NRG Oncology SDMC (1U10 CA180822) and NRG Operations (U10CA180868). The following Gynecologic Oncology Group member institutions participated in the primary treatment studies: University of Oklahoma Health Sciences Center, Women and Infants Hospital, Ohio State University Comprehensive Cancer Center, University of Virginia, Carolinas Medical Center/Levine Cancer Institute, Metro-Minnesota CCOP, University of California Medical Center at Irvine-Orange Campus, Wayne State University/Karmanos Cancer Institute, Froedtert and the Medical College of Wisconsin, Washington University School of Medicine, University of Wisconsin Hospital and Clinics, Baystate Medical Center, Cancer Research for the Ozarks NCORP, Mainline Health CCOP, University of New Mexico, University of Massachusetts Memorial Health Care, Case Western Reserve University, The Hospital of Central Connecticut, Evanston CCOP-NorthShore University Health System, Michigan Cancer Research Consortium Community Clinical Oncology Program, Northern Indiana Cancer Research Consortium, Northwestern University, University of Colorado Cancer Center – Anschutz Cancer Pavilion, Rush University Medical Center, State University of New York Downstate Medical Center, MD Anderson Cancer Center, University of Chicago and Wichita CCOP.
Keywords
- Care needs
- Ovarian cancer
- Quality of life
- Symptoms
ASJC Scopus subject areas
- Oncology
- Obstetrics and Gynecology
